Changes over a decade in psychotropic prescribing for people with intellectual disabilities: prospective cohort study

Henderson, A. , McSkimming, P., Kinnear, D. , McCowan, C. , McIntosh, A., Allan, L. and Cooper, S.-A. (2020) Changes over a decade in psychotropic prescribing for people with intellectual disabilities: prospective cohort study. BMJ Open, 10(9), e036862. (doi: 10.1136/bmjopen-2020-036862) (PMID:32912946)

Abstract

Objectives: To investigate psychotropic prescribing in the intellectual disabilities population over 10 years, and associated mental ill health diagnoses. Design: Comparison of cross-sectional data in 2002–2004 (T1) and 2014 (T2). Longitudinal cohort study with detailed health assessments at T1 and record linkage to T2 prescribing data. Setting: General community. Participants: 1190 adults with intellectual disabilities in T1 compared with 3906 adults with intellectual disabilities in T2. 545/1190 adults with intellectual disabilities in T1 were alive and their records linked to T2 prescribing data. Main outcome measures: Encashed regular and as-required psychotropic prescriptions. Results: 50.7% (603/1190) of adults in T1 and 48.2% (1881/3906) in T2 were prescribed at least one psychotropic; antipsychotics: 24.5% (292/1190) in T1 and 16.7% (653/3906) in T2; antidepressants: 11.2% (133/1190) in T1 and 19.1% (746/3906) in T2. 21.2% (62/292) prescribed antipsychotics in T1 had psychosis or bipolar disorder, 33.2% (97/292) had no mental ill health or problem behaviours, 20.6% (60/292) had problem behaviours but no psychosis or bipolar disorder. Psychotropics increased from 47.0% (256/545) in T1 to 57.8% (315/545) in T2 (p<0.001): antipsychotics did not change (OR 1.18; 95% CI 0.87 to 1.60; p=0.280), there was an increase for antidepressants (OR 2.80; 95% CI 1.96 to 4.00; p<0.001), hypnotics/anxiolytics (OR 2.19; 95% CI 1.34 to 3.61; p=0.002), and antiepileptics (OR 1.40; 95% CI 1.06 to 1.84; p=0.017). Antipsychotic prescribing increased for people with problem behaviours in T1 (OR 6.45; 95% CI 4.41 to 9.45; p<0.001), more so than for people with other mental ill health in T1 (OR 4.11; 95% CI 2.76 to 6.11; p<0.001). Conclusions: Despite concerns about antipsychotic prescribing and guidelines recommending their withdrawal, it appears that while fewer antipsychotic prescriptions were initiated by T2 than in T1, people were not withdrawn from them once commenced. People with problem behaviours had increased prescribing. There was also a striking increase in antidepressant prescriptions. Adults with intellectual disabilities need frequent and careful medication reviews.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McIntosh, Dr Alasdair and Mcskimming, Mrs Paula and Henderson, Mrs Angela and Mccowan, Professor Colin and Cairns, Professor Deborah and Cooper, Professor Sally-Ann and Allan, Mrs Linda
• Authors: Henderson, A., McSkimming, P., Kinnear, D., McCowan, C., McIntosh, A., Allan, L., and Cooper, S.-A.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: BMJ Open
• Publisher: BMJ Publishing Group
• ISSN: 2044-6055
• ISSN (Online): 2044-6055
• Copyright Holders: Copyright © Author(s) (or their employer(s)) 2020
• First Published: First published in BMJ Open 10(9):e036862
• Publisher Policy: Reproduced under a Creative Commons license

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
302957		Mental Health Data Pathfinder	Daniel Smith	Medical Research Council (MRC)	MC_PC_17217	HW - Mental Health and Wellbeing